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Compact case
Case
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Reference no. IMD-3-1463
Published by: International Institute for Management Development (IMD)
Originally published in: 2004
Version: 06.12.2004

Abstract

This is the first of a four case series. Aiming to contain vast and fast-rising expenditure levels estimated to amount to 8.2% of GDP (gross domestic product) across OECD (Organisation of Economic Co-operation and Development) countries in 2003, national healthcare reforms cannot avoid rationing; that is withholding beneficial interventions from needy individuals. Yet, a substantial part of a nation's healthcare spending is typically diverted in illicit ways, rendering otherwise feasible care unattainable and undermining the legitimacy of private and public services. In the US, healthcare fraud and abuse reportedly accounts for around 10% of total outlay, ie $120 billion per year. In the UK prescription crime in 2003 was estimated to amount to £115 million. In Lower Saxony, one of Germany's 16 Lander, insurance fraud alone accounted for 40 million euros in 2003. But cases are not always clear-cut and not always easily dealt with. There is often substantial ambiguity in defining what is actually improper conduct, identifying such behaviour among vast numbers of cases that are handled annually, telling errors apart from criminal intent, and choosing adequate regulatory responses.
Location:
Industry:
Other setting(s):
2003-2004

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Abstract

This is the first of a four case series. Aiming to contain vast and fast-rising expenditure levels estimated to amount to 8.2% of GDP (gross domestic product) across OECD (Organisation of Economic Co-operation and Development) countries in 2003, national healthcare reforms cannot avoid rationing; that is withholding beneficial interventions from needy individuals. Yet, a substantial part of a nation's healthcare spending is typically diverted in illicit ways, rendering otherwise feasible care unattainable and undermining the legitimacy of private and public services. In the US, healthcare fraud and abuse reportedly accounts for around 10% of total outlay, ie $120 billion per year. In the UK prescription crime in 2003 was estimated to amount to £115 million. In Lower Saxony, one of Germany's 16 Lander, insurance fraud alone accounted for 40 million euros in 2003. But cases are not always clear-cut and not always easily dealt with. There is often substantial ambiguity in defining what is actually improper conduct, identifying such behaviour among vast numbers of cases that are handled annually, telling errors apart from criminal intent, and choosing adequate regulatory responses.

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Location:
Industry:
Other setting(s):
2003-2004

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